Retina Injury After Dexamethasone Injection Into a Vitrectomized Eye

Abstract

Purpose: This work reports a case of retinal and vitreous hemorrhage after a dexamethasone (Ozurdex, Allergan) intravitreal implant injection to treat clinically significant macular edema (ME) in a patient with moderate nonproliferative diabetic retinopathy. Methods: A 61-year-old woman who had a vitrectomy 3 years prior in the right eye underwent intravitreal dexamethasone implant injection in the right eye. Immediately after the injection, the patient noted numerous floaters, with visual acuity decline from 20/30 before injection, to counting fingers at 3 feet after injection. Dilated examination revealed the dexamethasone implant resting against the retina, just inferior to the inferior arcade. On 360° fundus examination, the retina was found to be flat and attached. Optical coherence tomography of the macula demonstrated that the dexamethasone implant was preretinal, possibly having lifted the internal limiting membrane. Results: Thirty minutes after the injection, the patient reported that her vision was starting to clear. The patient was informed about what had transpired and warned about signs and symptoms of retinal detachment. She canceled her 1-week follow-up appointment because her vision returned to baseline. By 4 weeks post injection, her vision was 20/20 without macular edema. Conclusions: This case represents the first reported instance in which retinal impact by an Ozurdex implant was observed without treatment and vision recovered to baseline.

Iatrogenic Macular Hemorrhage after Dexamethasone Implant Injection

“…This is especially important considering the potential additional risks for iatrogenic injury related to preexisting general conditions or the use of bloodthinning medications. Given the comparatively high rate of bleeding or vitreous hemorrhage after minor injuries in this patients and the high rate of spontaneous remission of traumatic hemorrhages, a therapeutic vitrectomy might be deferred [2].…”

“…Retinal injuries and vitreous hemorrhage resulting from Ozurdex implant injection are attributed to direct and/or indirect tissue injuries 1 , 2 . Therefore, for safe administration techniques, one should consider any preexisting vitreous and/or retinal surgeries, and also the regular use of oral anticoagulants.…”